Needle Exchange Programs Shown to Slow H.I.V. Rates

By FELICIA R. LEE

Published: November 26, 1994

In the midst of a driving November rain, a woman in a stiff wig and a soiled trench coat approached a converted ice-cream truck in East Harlem and exchanged a brown-paper bag of used hypodermic needles for a bag of new ones. Into the bag went several condoms and the friendly admonition, "Use them; be safe."

It was just another day for the people inside the white truck that houses one of New York's needle-exchange programs. Intravenous drug users come to the van, which parks on the street, and trade used needles for new ones in an effort to slow the spread of AIDS through shared needles.

Now, for the first time in the course of a three-year study, researchers say they can document the success of that effort: a striking difference between participants in such needle-exchange programs and other intravenous drug users in their infection with H.I.V., the virus that causes AIDS.

A two-year evaluation of 2,500 participants in New York's effort, led by researchers at Beth Israel Medical Center's Chemical Dependency Institute, showed an H.I.V. infection rate of 2 percent a year, compared with 4 to 7 percent for high-frequency intravenous drug users not enrolled in needle-exchange programs.

The programs have grown to include 25,000 of the city's estimated 200,000 intravenous drug users. Many are like Julian Gonzalez, a 45-year-old heroin addict who lives in East Harlem and has been shooting up since he was 17. He used to go to "shooting galleries" or buy needles in the street, but says he has been more cautious about cleaning his skin and using clean needles since coming to the exchange.

"You take a chance when you buy needles in the streets," Mr. Gonzalez said the other day, as he stood in a whipping wind in a denim jacket and a black baseball cap turned backward. "The people here treat you good. Most of them are ex-addicts. That gives you some hope."

Proponents of needle-exchange programs say they have been vindicated by the findings of the New York study. The effort is considered an important national test because of the sheer number of intravenous drug users in the city, half of them believed to be infected with H.I.V.

Some critics have questioned whether needle-exchange programs that have shown benefits in smaller cities would be feasible on the scale required in New York, which has more than 70,000 cases of AIDS, the most of any city in the nation. Others object to such programs on principle, saying they legitimize and even encourage drug use.

The New York study, sponsored by the American Foundation for AIDS Research, Amfar, is the largest and most comprehensive evaluation of needle exchange ever conducted in the United States. It will continue for one more year. The sponsors' hope is that the findings will translate into Federal funds for needle-exchange and drug-treatment programs.

The foundation is conducting other needle-exchange research in Los Angeles, Chicago and Austin, Tex.

"We need to hold the science up in front of the policy makers," said the Rev. Margaret Reinfeld, the director of social and behavioral research at the foundation. "The challenge is translating what's learned at the community levels to a government structure that can support meaningful risk-reduction programs across the country." High-Risk Behavior Shows a Decrease

Supplying addicts with sterile syringes and supplies to clean their syringes and their skin does not necessarily prevent the use of shared needles and other practices associated with the spread of H.I.V. infection among drug users. But the study found that injection with rented syringes decreased 75 percent; injection with borrowed syringes decreased 62 percent, and the use of alcohol swabs before injecting went up by 150 percent.

Participants in the study range in age from 19 to their mid-60's, and tend to be long-term users, having injected drugs for an average of 17 years, three times a day. They were found to have injected drugs slightly less frequently over time, a finding attributed to greater health awareness from participation in the needle exchange.

Those findings were presented earlier this month at the American Public Health Association Conference in Washington. The final evaluation should be ready next October.

"I think with this hard data, it will be hard not to do something," said Dr. Denise Paone, who is evaluating the study with Dr. Don C. Des Jarlais, the director of research at the Chemical Dependency Institute. "I think there's going to be a turnaround. This has real implications for costs to the public health-care system."

Some experts, however, are taking a wait-and-see attitude until the final results of the Beth Israel study are released and other studies are submitted to peer review.

"Theoretically, I'm in favor of needle exchange," said Dr. Lawrence S. Brown Jr., senior vice president for the division of medical services evaluation and research of the Addiction Research and Treatment Corporation, which runs drug treatment programs in New York City. "Going from theory to practice is a big leap of faith. It's going to be difficult to prove efficacy."